The effect of neuraxial versus general anesthesia techniques on postoperative quality of recovery and analgesia after abdominal hysterectomy: a prospective, randomized, controlled trial.

摘要

BACKGROUND: Patients undergoing abdominal hysterectomy often have significant postoperative pain despite the use of concurrent multimodal pain strategies. Neuraxial anesthesia has opioid-sparing effects and may provide better postoperative recovery to patients when compared with general anesthesia. Our main objective in this study was to compare the effects of neuraxial and general anesthesia on postoperative quality of recovery after abdominal hysterectomy. METHODS: The study was a prospective, randomized, controlled clinical trial. Seventy healthy females were recruited and randomized to a general anesthesia or neuraxial technique as their primary anesthetic regimen. The primary outcome was the global quality of recovery-40 questionnaire (QoR-40) at 24 hours after the surgical procedure. Other data collected included postoperative pain scores and opioid consumption. Data were analyzed using the Mann-Whitney U test, Fisher's exact test, and linear regression. A P value <0.05 was considered statistically significant. RESULTS: The median difference (95% confidence interval [CI]) in the global QoR-40 score at 24 hours between the neuraxial and general anesthesia groups was 17 (11 to 21.5) (P < 0.001). Patients in the neuraxial anesthesia group had better quality of recovery scores in all the QoR-40 subcomponents than did the general anesthesia group (all P < 0.005). The median difference in global QoR-40 scores at 48 hours between the neuraxial anesthesia and the general anesthesia groups was 8 (6-10) (P < 0.001). Postoperative opioid consumption and pain scores were higher in the general anesthesia group than in the neuraxial anesthesia group. There was an inverse linear relationship between opioid consumption and postoperative quality of recovery at 24 hours, r(2) = 0.67 (P < 0.0001, 95% CI of 0.77 to 0.51), and at 48 hours, r(2) = 0.58 (P < 0.0001, 95% CI of 0.72 to 0.42). CONCLUSION: Neuraxial anesthesia provides better quality of recovery than does general anesthesia for patients undergoing abdominal hysterectomy. The opioid-sparing effects of neuraxial anesthesia were associated with a better quality of recovery in patients after the surgical procedure. In the absence of contraindications, neuraxial anesthesia seems to be a better anesthetic plan for those patients.